Dr Siddhartha Mukherjee, a Pulitzer
Prize-winning professor of medicine from Columbia University, called on
the World Health Organization to remove cellphone radiation from the
list of carcinogens in a lecture he presented in New Delhi.

Why am I not surprised?

Because on April 13, 2011,
shortly before the International Agency for Research on Cancer (IARC)
declared that radio frequency energy, including cell phone radiation, is
"possibly carcinogenic" in humans, Dr. Mukherjee published an article
in the New York Times Magazine, "Do Cellphones Cause Brain Cancer?" (http://bit.ly/1ttBlCA)
He argued that "not a single trial or test that
has attributed carcinogenic potential has been free of problems," and
labeling something "potentially cancer-causing" is "like crying 'wolf'
about cancer."

IARC uses five categories to classify the carcinogenic risk of thousands of agents, mixtures, and exposures:

Apparently, Dr. Mukherjee would like IARC to use only Groups 1 and 4 as he does not like "shades of gray." He forgets that the absence of
conclusive evidence of harm is not evidence of safety. Perhaps we should
stop warning people about ultraviolet radiation as this exposure is classified in
Group 2A? Whatever happened to the "better safe than sorry message"?

In his recent lecture, he asserted, "But I am willing to
revise this assessment if
there is additional data available" to which my reply is "read the
peer-reviewed research published since you wrote your article in 2011."
We have additional evidence of carcinogenicity in humans. In fact, two
peer-reviewed papers have been published making the case for a stronger
classification for cell phone radiation's carcinogenicity.

On April 21, 2011, I wrote Dr. Mukherjee the letter which
appears below. I argued the case why my colleagues and I believe that
cell phone radiation is carcinogenic. I have yet to receive a reply.

By the way, I have no conflicts of interest; Dr. Muhkerjee's recent
lecture was co-sponsored by the cellphone operators association of
India.

Summary: Calls for revision of World Health Organization’s list of carcinogens, says not enough data to establish the link.

India-born oncologist Dr Siddhartha Mukherjee on Monday urged World
Health Organization to remove cellphone radiation from the list of
carcinogens on the ground that the “preponderance of evidence suggests
there is no link” between radiation from mobile phones and cancer. In an
event sponsored by COAI (formerly known as Cellphone Operators
Association of India), India International Centre and Open Health
Systems Laboratory, he delivered a lecture making a strong case for the
revision.Dr Mukherjee, author of the Pulitzer winning book The Emperor of All
Maladies: A Biography of Cancer that was published in 2010, is currently
in India to accept the Padmashree award. He is an assistant professor
of medicine at Columbia University and a staff physician at Columbia
University Medical Center in New York City.In a recent article in The New York Times he had argued that the
drastic increase in cellphone usage does not mirror incidence of brain
cancer, neither is the radiation emitted by cellphones of the nature
that can directly damage DNA. He also termed as “loose” WHO’s definition
of “possible carcinogens”, some of which “defies logic” in their
proclivity to be more conservative.However, he says, “The last word has not been said on the matter of
cellphone radiation and cancer. The interphone trials (that sought to
examine the link) have a serious recall bias — people did not always
correctly recall the extent of their cellphone usage. There is a need to
examine how radiation of that wavelength can be carcinogenic. I would
ask WHO to downgrade cellphone radiation in the list of carcinogens,
which includes coffee. But I am willing to revise this assessment if
there is additional data available.”But he says there is not enough data to make a similar claim about radiation emitted by cellphone towers ...

First, I would like to congratulate you on your Pulitzer Prize. I look forward to reading your book.

I am writing you about your recent New York Times magazine article
and NPR interview about cell phone radiation and brain tumor risk.
Although I agree that epidemiologic research does not yield conclusive
evidence, my colleagues and I have carefully read and analysed this
research and conclude that the evidence is highly suggestive of
increased brain tumor risk due to prolonged cell phone use.

My colleagues and I published a meta-analysis of 23 case-control
studies (Myung, SK, Ju W, McDonnell DD, Lee YJ, Kazinets G, Cheng C-T,
Moskowitz JM. Mobile phone use and risk of tumors: A meta-analysis.
Journal of Clinical Oncology. 2009. 27(33):5565-5572). Although overall
we found no evidence of increased tumor risk (including brain, eye,
facial nerve, salivary gland, NHL), in our opinion it is a mistake to
simply look at the “weight of the evidence” as many scientific
committees and government health agencies have done, because not all of
the evidence warrants equal weight. In our meta-analysis, cell phone use
was associated with significantly increased tumor risk in the high
quality or non-industry-funded studies, and significantly associated
with decreased tumor risk in the low quality or industry-funded studies.
The latter findings were most likely attributable to bias. Moreover, we
found that 10 or more years of cell phone use was associated with
significantly increased brain tumor risk. Another recent review obtained
similar results (Khurana VG, Teo C, Kundi M, Hardell L, Carlberg M.
Cell phones and brain tumors: a review including the long-term
epidemiologic data. Surgical Neurology. 2009. 72(3):205-14.)

Since these two review papers were published, pooled results from
the Interphone study were published from data collected in 13 nations
between 2000 and 2004 (Interphone Study Group. Brain tumour risk in
relation to mobile telephone use: Results of the INTERPHONE
international case-control study. International Journal of Epidemiology.
2010. 39(3):675-694). Like many other epidemiologic studies, most
participants in Interphone hardly used cell phones. In fact, the typical
user had fewer than 100 hours of lifetime use. Furthermore, as you know
brain tumors can take decades to develop so it’s unrealistic to expect
to see increased tumor risk in the short term. The typical user in the
Interphone study had their phones for about five years.

We agree that the quality of the epidemiologic research has been
problematic, and that one cannot draw causal inferences from
case-control studies. The Interphone study had numerous problems which
have been discussed in the literature (Morgan, LL. Estimating the risk
of brain tumors from cellphone use: Published case-control studies.
Pathophysiology. 2009. 16(2-3):137-147). However, most of these biases
work against finding increased tumor risk.

Nonetheless, the study found
increased risk of glioma in the highest decile of use group (i.e.,
lifetime cell phone use of 1,640 or more hours). This finding held up in
44 sensitivity analyses that controlled for potential study biases
including the concern that some glioma patients may have exaggerated
their cell phone use. (Also, a separate methods study indicated that
recall bias was not differential for cases and controls.)

The final analyses reported in the second appendix to the Interphone
study corrected for what was likely the most important study
bias—participation bias. These analyses found a “dose-response
relationship”—increased glioma risk with increasing number of years of
cell phone use. Among those who used cell phones 10 or more years,
Interphone found more than a doubling of glioma risk compared to cell
phone users of less than 2 years. These results were similar to those
found in a study conducted by Lennart Hardell and colleagues in Sweden.
(In these analyses, the risk estimate for the highest decile of use
group increased from 1.40 reported in Table 2 to 1.80.)

Three Interphone study investigators including the lead
investigator, Elisabeth Cardis, along with Siegal Sadetzki and Bruce
Armstrong, have recently called for precautionary health warnings. About
a dozen nations have issued warnings to limit children’s cell phone use
or to keep cell phones a safe distance from the body, especially the
head and genitals. Typical recommendations include use of a wired
headset, speakerphone or text and not use phones in locations with weak
signals or in moving vehicles.

In addition to the epidemiologic evidence for tumor risk, there is
considerable evidence from animal and cellular studies of biologic
reactivity to cell phone radiation. Here, too, the evidence is
inconsistent, but according to a review by Henry Lai, the research
conducted independent of industry funding was far more likely to find
harmful effects than industry-funded studies.

The U.S. government needs to cultivate and fund a scientific
community that operates independent of industry for us to develop an
unbiased, scientific knowledge base that can be used to develop policies
that minimize population health risks from the adoption of EMF
technologies. A $1 per year fee on cell phones would generate $300
million annually for this work.

Although brain tumors are rare and the research on cell phone
radiation is not yet conclusive, with more than 300 million cell phones
in use in the U.S. we believe it is imprudent from a public health
standpoint to wait before issuing precautionary health recommendations.
At a minimum, precautionary principle actions are immediately warranted.

Please feel free to call me if you would like to discuss these issues.